What Are Azoospermia and PESA/TESA?
Azoospermia is a condition in which no sperm are found in a man’s semen, and it may have various causes.
Sperm production and transport involve a system of tubes within the male reproductive system. Sperm are initially produced in thin tubes in the testicles called seminiferous tubules. In each testicle, these tubules connect to a larger coiled tube called the epididymis, where sperm are stored for a short period after production. The epididymis is also connected to the vas deferens, which leads to the urethra. During ejaculation, sperm must move through this system in order to be present in the semen.
Azoospermia may result from an abnormality or obstruction in the epididymis or vas deferens. This is called obstructive azoospermia. In these cases, sperm are produced in the testicles but cannot pass out.
However, in some cases, sperm production in the seminiferous tubules does not occur at all, or occurs at such a low level that sperm cannot be detected in the ejaculate. This is called non-obstructive azoospermia.
Using surgical procedures to try to retrieve sperm from the epididymis (PESA) or to obtain tissue from the testicle containing tubules (TESA) can be an effective way to diagnose the cause of azoospermia.
More importantly, these procedures can also be effective methods of isolating sperm for use in treatment in order to achieve pregnancy. Even in non-obstructive azoospermia, as long as some sperm production is present, PESA/TESA may be an effective way to obtain sperm for use in treatment.
Who Can Benefit from PESA/TESA?
Possible causes of the absence of sperm in the ejaculate include:
- Testicular problems causing poor sperm production. These may result from various factors such as genetic problems, previous infection, for example mumps, or undescended testicles.
- An irreversible obstruction in the genital tract, possibly caused by a previous infection, trauma, or surgery.
- Congenital absence of the vas deferens, meaning absence from birth, which is common in carriers of cystic fibrosis.
- A previous vasectomy or a failed vasectomy reversal.
What Do These Procedures Involve?
PESA involves passing a fine needle through the skin into the epididymis in order to obtain sperm. TESA involves passing a fine needle directly through the skin into the testicles and removing a small number of seminiferous tubules. The tubules are then dissected in the laboratory, and their contents are examined for the presence of sperm.
Both of these surgical procedures can be performed under local anesthesia or sedation. Your doctor will discuss with you which approach is most suitable for your situation.
How Is PESA/TESA Sperm Used?
The number of sperm obtained through PESA or TESA is usually much lower compared with the number found in the ejaculate. Therefore, the sperm generally needs to be used together with a special type of IVF called ICSI, or intracytoplasmic sperm injection. Please see the separate information form. Surgically retrieved samples are rarely suitable for use in intrauterine insemination (IUI).
Your partner will undergo an IVF cycle, and after her eggs are collected, usually on the same day as PESA or TESA, your sperm will be injected directly into her eggs. This procedure is called ICSI. The fertilized eggs are then cultured in the laboratory for several days before a healthy embryo is transferred into your partner’s uterus.
Sometimes, enough sperm can be obtained so that some may be frozen for use in future ICSI cycles.
What Is the Success Rate of This Procedure?
IVF treatment using PESA or TESA sperm is a routine procedure at Life Fertility Clinic and has a success rate similar to IVF/ICSI performed using fresh sperm produced at the clinic.